As Affordable Care Act Marketplaces (Exchanges) Prepare to Go Live Oct. 1, CHECKBOOK Experts Share Advice to Help Consumers Make Best Health Plan Choices for Themselves, Their Families

Making a Smart Plan Decision Could Save Consumers Thousands, Improve Their Access to Quality Health Care

WASHINGTON, Sept. 4, 2013 /PRNewswire-USNewswire/ -- Millions of consumers will for the first time be able to choose among multiple health insurance plans beginning Oct. 1, 2013 (with coverage to begin Jan. 1, 2014), in the health insurance marketplaces (exchanges) set up under the Patient Protection and Affordable Care Act ("Obamacare"). Making the right choice can save many of these consumers thousands of dollars and help them get much better health care than if they make other choices. To assist them, Consumers' Checkbook, a nonprofit consumer organization that has been helping consumers choose health plans for more than 34 years, has put together the following tips.

To Keep Costs Down

• Check what you'll have to pay in premiums—but don't go by premium alone because the plans with the lowest premiums will often cost you much more than other plans when you take into account out-of-pocket costs including deductibles, coinsurance, and out-of-pocket limits.
• Compare what you might have to pay out-of-pocket. See if the marketplace website gives you a single dollar-amount average total cost for people like you—same age, family size, etc. Because comparing out-of-pocket costs can be very difficult and confusing, some marketplace websites (such as Massachusetts' and Colorado's) will be giving such total-cost estimates and others may have this capability soon (unfortunately, the federal government's website, which will be used by many states, will not initially have this feature).
• Don't choose based on deductible alone. Plans with low deductibles often prove to be very expensive—especially if they have high coinsurance or don't have a low limit on the most you could ever have to pay if you have an unexpected disease of accident.
• Try to find an estimate of your risk—what your total cost would be in a year if you have very high health-care usage. Some plans are good on average but leave you with very high costs in a bad year. A few marketplaces are set up to give you such bad-year estimates for each plan; others may offer this help soon.

To Have a Good Choice of Doctors and Other Providers

• See if the marketplace lets you enter the names of doctors you know you would like to be able to see and then automatically tells you which plans have those doctors. If not, you will have to go to each plan's website to look at the plan's doctor directory (the federal government's website, will not initially have such an all-plan provider directory).
• If there are doctors you care a lot about and a plan lists them as available, follow up with a call to these doctors' offices to be sure the doctors intend to continue accepting insurance coverage from patients in the plan.
• If you don't have doctors you care about, this would be a good time to try to identify a preferred doctor or doctors—at least a good primary care doctor and maybe specialists of types you know you will want—and check whether any such doctor participates in plans you might consider.

To Get Good Care and Customer Service in a Plan

• Check what surveyed members have said about the plan. Many marketplaces will post the results of official, standardized surveys where the members rate, for example, the availability of good doctors when they need them, the helpfulness of plan websites and customer service staff, speed and fairness of claims handling, etc. 
• Check whether the plan provides services you might want to help you stay healthy or deal with medical problems. Some plans offer free weight-loss and fitness programs, stop-smoking programs, nurses to help sick patients manage care and coordinate care from multiple providers, etc. Look for evidence that a plan's programs really have a track record of success.

Words of Caution

• Be wary if a marketplace tries to give you a total estimate of out-of-pocket cost based on how many doctor visits, prescriptions, etc. you say you expect to have. That type of total cost estimate ignores possible very high expenses for accidents, diseases, etc. that you can't predict.
• The best plan for you or your family might not be the same plan as is best for other people with different ages, family makeup, health conditions, or other characteristics.
• Don't assume that the bronze, silver, gold, or platinum labels on plans tell you which plan will be cheaper for you. The lowest-cost silver plan might be $2,000 less expensive than the lowest-cost bronze plan for one family with certain age and health-care needs, and the opposite might be true for another family when considering premium and what you have to pay out-of-pocket.
• Be aware that you might have to pay back part or all of the tax credit the marketplace (exchange) tells you you'll get to help pay your premium. The tax credit is based on your family income in a prior year and you might have to pay some or all back on a future tax return if your income turns out to higher than what was used to figure the credit. If you are worried about that, you can choose to take a smaller credit.
• Even when looking at specific benefits, look at the details and exceptions. For example, when you see a figure for the maximum amount you will have to pay out-of-pocket in a year, check whether that limit applies to drugs.
• Don't narrow the list of plans you will consider without checking what you will be giving up. Some exchanges might ask you up front if you want to rule out joining an HMO or joining a plan that does not have your doctor. If you do such narrowing up front, you might never see plans that would cost you thousands of dollars less or that have great doctors and customer service.
• Don't rely too much on examples plans give of the costs for specific procedures or conditions. All plans are required to tell consumers how much the out-of-pocket costs will be for a normal childbirth and for a typical person with controlled diabetes. Check that information. But be aware that, for example, a plan might require members to pay a low portion of costs for childbirth but a relatively high portion for most other types of service.

For Additional Assistance

• Visit Healthcare.gov or call 1-800-318-2596 for more information; both the website and call center are operated by the U.S. Centers for Medicare and Medicaid services and are designed to provide information and put consumers in touch with resources related to the exchanges.

These tips are based on Consumers' Checkbook's research, consumer-testing, and experience helping consumers choose insurance plans. The organization has provided Checkbook's Guide to Health Plans in annual books and online since 1979, focused on helping 8 million Federal employees and retirees who get to choose plans in an insurance program that includes more than 200 plans. Based on this work, Checkbook has developed a website that stands out in the Consumer Reports Choice Architecture report comparing the major health plan comparison tools. Checkbook is working with various states helping them set up their marketplaces with easy ways to compare health plan costs, quality, and access to high-quality doctors. And Checkbook has created a model health plan comparison tool (at www.checkbook.org/plancompare) to guide states and the federal government in creating online tools that will make it easy for consumers to choose the right plan for their needs and preferences.

About Consumers' Checkbook/Center for the Study of Services
Consumers' Checkbook/Center for the Study of Services (www.checkbook.org) is a nonprofit organization whose mission is to inform the public about the quality and cost of available service providers, educate members of the public on how to select and deal with such providers, and disseminate information that can guide and motivate service providers to deliver higher quality, more efficient services.

Checkbook/CSS also has extensive experience collecting and processing health care quality measurement information under contract with government and other organizations that produce the information for public reporting on quality and cost of health plans and of health care providers.

CONTACT: Jamie Lettis
202.454.3006 [email protected]

SOURCE Consumers' CHECKBOOK/Center for the Study of Services